Abstract

Background In the UK in 2008, stroke was responsible for over 43,000 deaths. Dietary fibre intake may reduce stroke risk through modifying one or more risk factor such as body weight, blood cholesterol, or blood pressure. Food sources of fibre can be examined in relation to risk as different foods contain different types of fibre which have differing proposed actions within the body.

Methods 31,036 women recruited in 1995 provided dietary information relating to the previous 12 months using a 217-item food frequency questionnaire. Total dietary fibre intakes were estimated as both non-starch polysaccharide (NSP) and Association of Official Analytical Chemist (AOAC) values. Insoluble fibre, soluble fibre and fibre (NSP) from a variety of food sources were also examined. Stroke mortality was registered from baseline through the Office of National Statistics. Cox proportional hazard ratios were generated to explore risk using both categorical (fifths of intake) and continuous exposure variables. Model adjustments: age, body mass index, energy intake, ethanol, physical activity, smoking and socio-economic status.

Results After 14 years, 130 fatal stroke cases were observed. Fatal stroke risk was similar for total fibre assessed either as NSP or AOAC and both were protectively associated with risk. Overall, risk was roughly halved in each intake category compared to the lowest although this was only significant in the 3rd (NSP/AOAC) and 4th (AOAC) category. Those consuming 24 vs. 14g/d of NSP or 37 vs. 22g/d AOAC had their risk of stroke halved [Englyst: hazard ratio 0.47 (95% confidence interval 0.24, 0.92) p=0.028] [AOAC: 0.47 (0.25, 0.89) p=0.021]. For fibre from nuts and seeds, the highest intake category (0.85g/d) saw a 56% risk reduction [0.44 (0.23, 0.83), p=0.012] compared to the lowest (0g/d). Fibre from fruit was also protectively associated with risk of stroke in the 4th (5.8g/d) vs. 1st category (1.4g/d) [0.50 (0.25, 0.97), p=0.041]. These significant associations were not seen in every category comparison and results for continuous exposures were not statistically significant for any of the exposures explored. No association was observed with fibre from cereals, vegetables or legumes.

Conclusion Results suggest that fibre from certain food sources and not others may be more beneficial for prevention of stroke. This may occur because different foods contain fibre fractions in varying quantities. Non-significant results for the continuous exposures suggest associations may be non-linear. The results may also reflect benefits simply from ‘fruit’ or ‘nut and seed’ consumption rather than specifically fibre from these sources.

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